Frailty: can (and should) we measure it in younger populations?

Written by Dr. Gemma Spiers, Senior Research Associate 

Frailty is a much talked about, but often poorly understood, concept. It has been defined as ‘an increased vulnerability to stressors’. In plain English, this means that older people who are frail may not bounce back from infections or other insults to their health, as well as younger people might do.  The concept of frailty rarely resonates with older people, but it does help clinicians and researchers to understand the mechanisms of ageing and identify people at risk of poor health outcomes. Routine measurement of frailty is now common in UK health care services.  Frailty is assessed by both primary care and hospital teams, to inform the delivery of care for people aged over 65 years.

There is now emerging interest in whether the concept of frailty can be used with younger populations who are vulnerable because of long-term health problems.  This is not altogether surprising. People who are more disadvantaged are likely to experience age-related health problems earlier in life. However, age thresholds within healthcare will exclude younger groups from an assessment of frailty.

This growing interest has prompted questions about how frailty is measured and identified in younger groups, and whether doing so makes any difference to younger patients’ health or the care that they receive. Our rapid review, published this month in BMJ Open, explored these questions. Our work shows that some frailty measures can predict important health outcomes in studies that include younger groups. However, more evidence is needed to clarify whether frailty measures can be used across the adult age spectrum. Critically, we found no evidence about whether assessing frailty in younger people has any impact on their care or health.

Our review asked whether frailty can be measured in younger populations. But perhaps first we ought to ask should frailty be measured in younger groups? There is a broader issue to tackle with this topic. Is frailty – a construct used to further our understanding ageing – the same (and identifiable using existing tools) in younger populations?  Frailty assessments are commonly used in healthcare to identify older people who are vulnerable because of poor health. Taking the same approach with younger groups may be an attractive option. However, vulnerability from poor health manifests in different ways across the life-course. It is important to question whether a frailty assessment is a useful and valid way to assess this.

If we are to understand whether assessing frailty has a useful place within healthcare for younger populations, this is an important issue to consider. Alongside this, evidence is needed to tell us whether assessing frailty in younger groups makes any difference to patients’ health and the care they receive.

This post represents the views of the author and not those of the Older People and Frailty Policy Research Unit, Departments of Health and Social Care or the National Institute of Health and Care Research.